This Integrated Care Trust served a population of over half a million people spanning a number of English counties and employed over 6,000 staff. It offered a variety of acute care services and facilities, including its internationally recognised National Spinal Injuries Centre.
Following several previous successful engagements with the Trust, Meridian were tasked with identifying scope for improvement within the Outpatients Department. It was a known issue within the trust that clinic utilisation was low, but internally driven processes and systems had historically been unable to impact upon the levels of performance.
With a need to accommodate increasing demand in terms of patient referrals, but all within a shrinking cost envelope, a focus was placed upon the levels of slot utilisation, particularly at the point of booking.
An analysis was carried out on the running of the Outpatient Department, including a combination of observational and statistical studies. These studies highlighted opportunity within the clinics, predominantly in the levels of slots not booked.
The analysis findings were as follows:
- There was opportunity for improvement in terms of the levels of booked utilisation in the clinics held.
- There were no systematic prospective or retrospective follow-up processes in place to ensure that the resource was effectively planned.
- There was often misalignment between what consultants were contracted to deliver in clinic in terms of clinic time against the templates that were configured in the booking systems.
- There was a lack of simple management information and key performance indicators.
- The management control system in place was ineffective in optimising the performance of the department.
What Meridian proposed:
- To design and install a robust management control system to control the targeting, planning and reporting of productivity within the department.
- To decrease the levels of unbooked slots within clinics by implementing new behaviours and procedures in the booking teams.
The project commenced with a mapping of the booking process to establish the key control points of selecting patients and booking them into slots. From this mapping exercise, which was carried out with various members of the respective teams, it was possible to isolate the main areas in which increased control was required.
Through working with the booking team members, as well as members of the Patient Access management team, a series of simple controls were developed; including checklists, meeting agendas and performance reports. These controls were installed within the teams, allowing a significantly improved level of transparency on an hourly and daily basis regarding the planned utilisation of the clinic slots.
With advance review of the clinic slots, and a clear focus on unbooked capacity, the team were able to make the task of filling up all cancelled slots (in which patients had previously been booked) part of their routine process. This in turn led to a far reduced number of ‘perished’ slots when the clinic actually occurred.
Meridian worked closely with the booking teams to train and coach them through using the new controls. The team members were encouraged to input to the evolution of the new tools and they were tweaked and amended accordingly until the teams were entirely satisfied and comfortable with them.
The project focused on two divisions within the organisation. However, given the transferability of the new systems, the Trust decided to roll these out across the board. Meridian assisted the Trust in this regard by training up key members of the management team to facilitate this roll-out.
As the Trust was a matter of months away from implementing a brand new Patient Administration System (PAS), all tools were designed in a way that future-proofed them against changes in technology, and reliance on electronic systems was kept to a minimum.
- Annualised savings of £200,000 in reduced unbooked outpatient slots within the two divisions in scope.
- An extrapolated annualised improvement across all divisions of approximately £820,000.
- Reduced waiting lists due to higher levels of activity going through outpatient clinics.
- Development of a set of simple management controls to enable proactive management of the productivity levels of the department.
- The installation of a clear follow-up process within the booking teams, leading to better communication with management.
- The implementation of a new robust and future-proofed system of slot booking in advance of a large-scale migration in the Trust’s PAS system
- The translation (for the first time) of unbooked slots into a financial equivalent, helping to drive the performance of the booking teams with a strong new indicator.
- A far clearer understanding across the board of the level of performance within the department and the financial impact of the inefficient practice.